The aim of the present study is to evaluate if sinus lift surgery can cause further complications or a clear worsening health in patients with clinical or radiological manifestations affecting the sinus.
This study aims at verifying if, in cases of diagnosed alterations of normal sinus homeostasis or frankly pathological situations, they go through positive or negative alteration after sinus lift surgery, or if they can be considered as a real negative predictive factor of the prognosis of the rehabilitation.
METHODS: The sinus lift procedure was carried out to 28 edentulous patients with severe atrophy of the alveolar ridge.
The response to surgery was evaluated over time. 28 patients with chronic sinusitis caused by a thickened Schneiderian membrane were selected and 75 fixtures were placed after sinus augmentation according to Tatum’s technique.
The whole cohort of patients was initially subjected to OPT X-rays and DentaScan CT. 8 patients presented with slight alterations of the sinus membrane, 13 with membrane thickness within 5 mm, 7 with sinus opacity more than one third.
Examination of the Ears, Nose, and Throat (ENT) was recommended and an 8-day aerosol therapy (with antibiotic associated to 20 milligrams of cortisone per day) was administered before and after sinus lift surgery. The thickness of the residual basal bone was between 4 and 7 millimeters in 24 patients (one stage), while only in 4 patients it was less than 5 millimeters (two stage). Geistlich Bio-Oss® bovine bone (50% cortical and medullary and 50% with beta-tri-Calcium phosphate, puriss) and Sint Oss by “Industrie Biomediche e Farmaceutiche srl” were used, with the addition of growth factors from PRF®.
Control CT scan performed 12 and 24 months after surgery showed total regression of the thickened Schneiderian membrane in 8 patients; 13 cases appeared with approximately 5 millimeters of thickness with a 50% reduction; in the 7 cases with the most compromised maxillary sinuses, the results varied according to the disease the patient had from the beginning: 2 of the cases of almost total sinus opacity showed an important improvement of the clinical picture; the radiopacity was reduced by one third in one patient, while the pathology completely disappeared in three patients.
Only in one case there was no evident improvement. 100% of patients immediately perceived an improved nasal respiration; even in these 7 cases which were less suitable to undergo surgery, there was a success of the regenerative therapy and no worsening of the clinical picture, with a complete implant prosthetic success.
The examined sample is limited to draw definitive conclusions. Radiographic and clinical results confirm the beneficial effects in the immediate postoperative period, opening up encouraging prospects in the management of patients affected by chronic (non-pathological) sinusitis who can be subjected to implant rehabilitation of the atrophic jaw.
The hyperplastic and edematous membrane reduces the risk of perforation during surgical maneuvers and sinus lifting contributes to improve secretion drainage.
The association of resorbable biomaterials and growth factors from PRF® have certainly fostered a quicker transformation of the neo-apposed bone into mature bone (confirming implant stability) and a rapid reduction of the chronic inflammation affecting the hypertrophic Schneiderian membrane.
INCHINGOLO Francesco, MARINELLI Grazia, INCHINGOLO Angelo Michele, DE BENEDITTIS Michele, INCHINGOLO Alessio Danilo, SCHINCO Fabio, MARRELLI Massimo, TATULLO Marco, MURA Stefano, MALCANGI Giuseppina, COLELLA Alessandro, DIPALMA Gianna, CORTELAZZI Roberto.